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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS
<br />UNDER GROUND
<br />Water-Under Iloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Rool Drain
<br />Rouqh Water Heater
<br />POOL/SPA
<br />Ptrap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq
<br />Final Gas Test
<br />Meter Release I
<br />FINAL tdllt8
<br />Notes, Remarks, Etc.I
<br />OI\ NI]R BUII-Df,R DELCARA'IION
<br />I h{rcby iflnn Dndcr ,,ctrllry ol |x juy rh r I in cxcmpr toor rhc ContrNr.n Li.cns. ljw tu r hc fi,lk,eing rca$n ( sd ?0.r 1 .5
<br />Dusincss nrkl ltoicssn Cod.): Any Ciry or Cotrnly which rcquirc\ r pcrnrl n, coriru.r, ,lrcr. inuovc. Jcmolth .r rcnin ] y
<br />sln,du,c- pfttr h irs is\uah-'c. rlso (nuncs lhc lpnliclnl itrsuch |xnnlr i{' fih r \i!tr.d \t cnf,trr lh hcor \hc n liccnsd Pusu.nl
<br />rorhcpmvisionsolrhcconrrucktrtLiccnrcdl-tr*(Chit'rcr9.Conncming*irhSccrnn,TtxnofDivi\n:lofthsBurnr$Md
<br />Pn,Icsion\ ft,lc)orrhlr heorshc i\ ci.dpr rh.r.frumanJ rhc ba\i\ fdrhc rlLlcdcxonprio. AnyviolilnnrotSdirn'7011.5$y!o,
<br />rptli.int ror r Frmir suhjdh rhr rmli.a6r rJ rcrvrlpcnalrrornor'x,.than filc huftlr.d dollu^ (S5r)0)
<br />-1.
<br />!s oqncr of rh. pDpcrry, or n, cdplorEs qirh q.g.s &r rhct sk onpcnsrion. will do ft. so* !d lt* srurw h ml
<br />in'cidcd or oficrcd for slc (56 1)44, Burimss lod kofe*ions Codc Th. Contra.lols Lien* lw do6 ml .FIly lo u o{rcr of
<br />$c I'DIlny who hri*$ or itrp,ls tldetr aid wlb dctrh w hin$laor h.<o, rhmugh h!., h.r own.nplor.cs.
<br />pmvitu $nl3Eh ihpmmls m ml inl.nd.doro,IcEn for eb li heq.dE ldiui.sot ir{n*G h $ld within orc t&
<br />oamnplcrio|! tk Owmr Bril,q wi[ lEw dE hnd.n of pmvi4 tn h. c slE dn ml hrild s irlrow rhc popdty fq $. p{lrpo* of
<br />l. !s own$ ofrhc pm!.ny. m crclusiv.lyconhdin8 wirh liccnscd coflrrrcroF ro co.smd rh. pNjEr (SN.7044. Busrnes
<br />and A.Grsi,n Cod.: Thc Co.ro.rolr Liccnsc Loe d@s nor Eprlyro &own.r oapropcnywho builds or inlprcvcs lhcrco.,
<br />sd sho .onh.h for such nDjcds wnh I Coirftdon9 [ccird ,usuinr ro thc Conrrscror's Liccn$ bw).
<br />I am.xc rpr undoscciinn .A & P.C. tMrhi1rcr$n.
<br />gQ8trE8l:C9MfASA]lO!
<br />DECLAAAIION
<br />I h.rcby dlrrm uf,dd pcmhy ol psiury orc ofltE followin8 delsalions:
<br />IhJrcxndsill L'nti'rrCcn'li(rr.ofcon{irt,Srlll urcli sork.ri.'ntrnrri,rr.r\prri(ln)rhySNli,nir?lx)oIrhc
<br />lrh.r (-lnt.lnrrhc pcrlonrnccolrh. work rd*hi.[ rhc rcnni{ '\ rsdrd
<br />I h,vc .nd *ill minhin sorkc.l comp.nsotion insuntre. .s rcquircd hy Salnrn :1700 of rhc Lsbor Codc, r.r thc pctfo.mm of
<br />rhc work for whicn rnG Frmil is isnf,n. M, wortcrs' ompcisorion i.suotuc .antr 8nd rblicy nunb.r m:
<br />P.h.vNtrmh.r ErDirci
<br />_l .cnify rhd in rhc pcrfrrmec of rh. work {6r shkh rhis p.rnn k isrsd. I shall nol cmFloy ony ,c.son in any mner
<br />s ss ro b.om subjer ro llE wor'eB'com0cn$rion laws ofciliforni4 and asN rh.r it I .horld beo@ subiel lo llE
<br />*ort6 mmp.nstion pmiisions of Seclkrr 37m of rct lnr Codc I slEll. loahwnh @mply silh thos pmvisions..
<br />\ppli.rnr:
<br />UCENSEILCONIBACIA&
<br />DECIAEAIIAN
<br />I hcEbya0nm!.dcr peMltyorpcrjlrylhcl I !m liccn{n und( tn,vi\i{ orChapr.r 9 (connm.cnr8 wilh Secli.n 7000) ofDivhion 3
<br />of rhc ausift!! d Pmfcsio.s Codc, ad my liccn* n in tnll for ud elld.
<br />Lic.mc clasr-Lienk Nlnbcr
<br />caxsrB!]cluxl,};xDlNri-dcENl.l
<br />I herctyomrnundc! rEniny ol p.rjory rnd rhc,r isrconir crin, lcMin! rscnct lor lhc Pc omun cnirhcw.!k for {hich
<br />'hi\
<br />pcrtuir G
<br />issucd (Sc.. :l{}97. Civ. C ).
<br />AIILICANLD}:CLABAIII'
<br />I tEtby lnnuMcr |f.alry ot lErlury o.c oithc Inln)wirg dcclnorior\
<br />D.molirn,i Pcni( A\br\ro\ Norificarn,n Fcd(rl RcEULrn,ns(Tirld.{), Pad6)
<br />R.qunrd lxrrf of Norifi .nrirr
<br />I c.niry rhai rhc fcdml E8uldions Eg.rdinS lslEsros rcmvll N fr,r amlt3hlc to r,!h Dojcd
<br />-l
<br />ccni,yrhd I novc rcldthivpdiclrionlnd srarcrhrrrnca&,rc innrrndn'n h.oftc.r I asrN ro cunply wiln rll Cily snd Counry
<br />olniMnccsn Sratc tiqs Ehri.s ro hlildinB .ondo.rnnr, lnd h.rchylurhtrir 6prc\c ot,rcsoflhisCity.ndColnryrocnrcrllx)nlh.
<br />ib.rc m.rn d foFnt rbr insr.liotr pu.p.scs
<br />Applic.nl o. AE€nl SIAMI
<br />alra
<br />ID/SIG.
<br />Waste & Vent
<br />Tub/Shower Test
<br />Miscellaneous
<br />WAnNING: FailuE ro slr sorkelr @npinsatio. .ove6ge is unl,*tu|. md shrll subtrt an €mplo'tr lo oininal fEnahts &d
<br />cMl fin s ut, to oft hondbd rhousand dollds (!100.M)). i. oddilioo to lh. .ost of cohl,endion. &nuB.s rt tirovi,cd to. thc
<br />S*rion 30?6 of th. Llho C.dc. i.t@n .Jd lltomy's le..
<br />lrnda! Adlrsr-
<br />P.mile n.nr(prlnl):
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<br />II
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